To the Editors
We thank Dr. Muncie for identifying the need for clarification of the quality measure: “Osteoporosis Management in Women Who Had a Fracture.” This measure is endorsed by the National Committee for Quality Assurance (NCQA) and the National Quality Forum (NQF). While the manuscript stated that the measure assesses “receipt of appropriate bone density testing and pharmacotherapy within 6 months of a fragility fracture for women aged 67 and older” we agree that this phrasing is not consistent with the official measure wording. An “or” should replace the “and” in the sentence describing the quality measure. The phrase “and” was not meant to suggest that both were recommended but that receipt of bone density testing and pharmacotherapy post-fracture were each assessed in this quality metric.
Importantly, the primary outcome for this study was the receipt of bone density testing or prescription pharmacotherapy within the six months post-fracture which is consistent with the NCQA/NQF quality metric. Therefore this clarification of quality measure wording does not change the care we measured, our findings or the conclusion we draw in this study.
We appreciate the importance of providing cost-sensitive care and avoiding unnecessary care, however our study shows that an overwhelming majority of post-fracture patients received neither a bone density test nor a prescription for pharmacotherapy.
Acknowledgments
This work was funded through the following grants:
National Institutes on Aging K23AG035030 (Morden) and P01 AG019783
Robert Wood Johnson Foundation Dartmouth Atlas Project
National Institute of Arthritis and Musculoskeletal and Skin Diseases P60AR062799
Footnotes
Author Contributions:
All of the listed authors participated in the study concept and design, data analysis, interpretation of data, and preparation of the manuscript.
Sponsor’s Role: The grant sponsors had no input on the design, methods, analysis or preparation of this paper.
Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Stephen Liu has received training grant funding from the Department of Health and Human Services, the University of Colorado and the Hartford Foundation for projects not related to this study or paper.
Stephen Liu is a consultant for the Oak Group which produces the Managed Care Appropriateness Program (MCAP) Clinical Review Criteria. This consultant work was not related to the design, methods, analysis or preparation of this paper.
References
- 1.National Quality Forum. [Accessed October 22, 2012.];Osteoporosis management in women who had a fracture. STEWARD: National Committee for Quality Assurance [on-line] Available at http://www.qualityforum.org/QPS/0053.
- 2.Liu SK, Munson JC, Bell JE, et al. Quality of osteoporosis care of older Medicare recipients with fragility fractures: 2006 to 2010. J Am Geriatr Soc. 2013;61:1855–1862. doi: 10.1111/jgs.12507. [DOI] [PMC free article] [PubMed] [Google Scholar]